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Providence Health & Services Request Specialist - Utilization Management in Mission Hills, California

Description:

Apply today! Applicants that meet qualifications will receive a text with additional questions from our MODERN HIRE screening and interview system.

Providence is calling a Request Specialist, (Full Time Day Shift) to Providence Facey Medical Foundation in Mission Hills, CA.

Please upload a current resume reflecting all professional nursing experience.

We are seeking a Request Specialist who will demonstrate competency and knowledge in HMO/EPO/PPO eligibility and benefit coverages. Serve as a liaison between patients, hospitals, health plans, and Facey Medical Foundation and Facey Medical Group. Responsible for verification of eligibility and benefits for managed care members.

In this position you will have the following responsibilities:

  • Deliver upon the service expectations of both our patients and fellow staff members by listening to their needs; engaging in positive interactions; and following through on promises made in a thoughtful, efficient, timely and courteous manner so that their total outcome is better than expected

  • Work in a safe manner, adhering to general safety precautions and standards. Report any unsafe conditions to their supervisor and/or the safety hotline

  • Verify eligibility, benefits, and researches medical criteria for HMO assigned patients and updates the member’s records as necessary

  • Report discrepancies of copay/benefit between health plan’s source documents and internal Facey system

  • Ensure requests are submitted timely and accurately prior to entry into the system

  • Communicate with providers when requests lack information

  • Report referral counts daily to Request Specialist Lead

  • Research, reconcile, and update service authorizations on claims research requests. Enter extensions of dates, new authorizations, and/or confirms denials (per Case Manager’s review)

  • Input retrospective authorizations into various systems

  • Call on-call physicians for emergency authorizations and inputs into the system real time

  • Serve as liaison between patients, providers, and the organization regarding benefits and eligibility

  • Notify patients and providers of routine authorizations or denials by mail and fax

  • Notify patients and providers of urgent or stat authorizations or denials by phone

  • Interface with patients directly, and schedules appointments accordingly

  • Handle phone calls from patients, hospitals and outside providers regarding inquiries on insurance benefits, authorizations, hospital bills and dates of service

  • Input authorizations and tracks patients with HIV or on dialysis

  • Assist case managers by gathering necessary information needed for review and assists with outbound calls to patients

  • Complete required patient notification letters (e.g. extension, carve out, denial, approval letters)

  • Forward any investigational or experimental requests to the patient’s health plan for review

  • Attend required/assigned meetings by the supervisor and manager

Qualifications:

Required qualifications for this position include:

  • 1 year experience in a clinic, hospital or related health care industry in a managed care environment, or equivalent in education or medical certification in medical field (i.e. nursing, medical billing and coding, or medical admin assisting)

  • Data entry experience

  • Knowledge of HMO/EPO/PPO insurance processing, ICD-9 and 10/CPT coding and medical terminology, a plus

  • Ability to use 10-key calculator by touch or sight

  • Type 45 wpm

  • Computer skills (MS Word, Outlook and Excel)

  • Ability to multi-task and prioritize

  • Possess excellent customer service and communication skills, answer Customer Service call line calls and data entry, be organized and self-starter

About the organization you will serve:

Facey Medical Group is a multi-specialty medical group with over 160 physicians providing care to the growing population in the North & East regions of Los Angeles & Ventura Counties. Twelve medical clinics, including two urgent care centers and dedicated women's centers, are located across the San Fernando, Santa Clarita and Simi Valleys. The group began as a single medical practice over 90 years ago.

Facey is part of Providence Health & Services, an integrated, not-for-profit 5-state network of hospitals, care centers, medical clinics, affiliated services and educational facilities spanning from California to Alaska.

We offer comprehensive, best-in-class benefits to our caregivers. For more information, visit

https://www.providenceiscalling.jobs/rewards-benefits/

Our Mission

As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.

About Us

Providence is a comprehensive not-for-profit network of hospitals, care centers, health plans, physicians, clinics, home health care and services continuing a more than 100-year tradition of serving the poor and vulnerable. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.

Schedule: Full-time

Shift: Day

Job Category: Patient Services

Location: California-Mission Hills

Req ID: 307906

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